Up Front MattersReassessing Medical Risk in Living Kidney DonorsGaston, Robert S.*; Kumar, Vineeta*; Matas, Arthur J.† Author Information *Division of Nephrology and Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama; and †Department of Surgery, University of Minnesota, Minneapolis, Minnesota Correspondence: Dr. Robert S. Gaston, Division of Nephrology, University of Alabama at Birmingham, 1900 University Boulevard, 625 THT, Birmingham, Alabama 35294. Email: [email protected] Journal of the American Society of Nephrology 26(5):p 1017-1019, May 2015. | DOI: 10.1681/ASN.2014030227 Buy Metrics Abstract The short- and long-term effects of unilateral nephrectomy on living donors have been important considerations for 60 years. Short-term risk is well established (0.03% mortality and <1% risk of major morbidity), but characterization of long-term risk is evolving. Relative to the general population, risk of mortality, ESRD, hypertension, proteinuria, and cardiovascular disease is comparable or lower. However, new studies comparing previous donors with equally healthy controls indicate increased risk of metabolic derangements (particularly involving calcium homeostasis), renal failure, and possibly, mortality. We discuss how these results should be interpreted and their influence on the practice of living donor kidney transplantation. Copyright © 2015 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.